Suzanne R. Sunday

Psychiatric comorbidity in patients with eating disorders

The Structured Clinical Interview for DSM-III-R (SCID and SCID II) was administered to 105 eating disorder in-patients in order to examine rates of comorbid psychiatric disorders and the chronological sequence in which these disorders developed. Eighty-six patients, 81.9% of the sample, had Axis I diagnoses in addition to their eating disorder. Depression, anxiety and substance dependence were the most common comorbid diagnoses. Anorexic restrictors were significantly more likely than bulimics (all subtypes) to develop their eating disorder before other Axis I comorbid conditions. Personality disorders were common among the subjects; 69% met criteria for at least one personality disorder diagnosis. Of the 72 patients with personality disorders, 93% also had Axis I comorbidity. Patients with at least one personality disorder were significantly more likely to have an affective disorder or substance dependence than those with no personality disorder.

The Tridimensional Personality Questionnaire : An exploration of personality traits in eating disorders

The Tridimensional Personality Questionnaire (TPQ) was tested in four subgroups of eating-disorder patients: anorectic-restrictors (AN-R), anorectic-bulimics (AN-B), normal weight bulimics (BN), and bulimics with a past history of anorexia (B-AN). Normal controls and patients were matched for gender and age. All subjects completed the Beck Depression Inventory (BDI) in addition to the TPQ. AN-Rs scored lower on the Novelty Seeking scale than the bulimic groups and controls, and the two normal weight bulimic groups had higher Novelty Seeking scores than the controls. On the Harm Avoidance scale, all eating disorder groups scored significantly higher than the control group. In addition, the AN-Rs scored lower than the AN-Bs and B-ANs. The Harm Avoidance scale and depression scores were positively correlated while the Reward Dependence scale and depression scores were negatively correlated. Differences between diagnostic groups on the Novelty Seeking and Persistence scales remained clearly significant when depression was partialled out. These results are discussed in terms of the Tridimensional Personality Questionnaire as a stable measure of traits with eating disorder subjects.

Smoking and body image concerns in adolescent girls

OBJECTIVE Use of cigarettes has increased dramatically among adolescent females. Because young women use smoking as a weight control strategy, increased drive for thinness and body dissatisfaction may be associated with smoking. This study examined the relationship between smoking and body image concerns among adolescent females with and without eating disorders. METHODS Incidence of smoking and Eating Disorders Inventory (EDI) scores were compared among 411 nonclinical females and 82 eating disorder females with anorexia nervosa or bulimia nervosa aged 11 to 18. RESULTS Of the three groups, anorectic-restrictors were the least likely and bulimics the most likely to smoke. After covarying age, both eating disorder and nonclinical smokers had significantly greater psychopathology on Drive for Thinness, Body Dissatisfaction, and Interoceptive Awareness than nonsmokers. DISCUSSION Despite high levels of body image disturbance, anorectic-restrictors did not use smoking as a weight control strategy. Body image concerns were more prevalent in smokers than in nonsmokers.

Micro- and Macroanalyses of Patterns Within a Meal in Anorexia and Bulimia Nervosa ☆ ☆☆ ★ ★★

Hospitalized women with anorexia nervosa and/or bulimia nervosa and dietarily restrained and unrestrained, clinically normal women were provided with a multi-item breakfast meal. Eating patterns and hunger and satiety ratings were assessed. Subjects were offered three foods which varied in fat and carbohydrate contents. Anorectic-restrictors differed most from the control subjects: they had a longer meal duration, a slower overall rate of eating, more frequent pauses during the meal, and more short bouts of eating. They also displayed abnormal ratings of hunger and satiety: they were generally less hungry, had less urge to eat, and were more full than controls of bulimics. Both anorectic and bulimic patients showed more variability in total energy intake than did the controls. Patients usually displayed one of two patterns - either severe restriction or overeating. Abnormal hunger and satiety patterns indicating confusion typified the responses of bulimics; additionally, they showed more urge to eat in the post-meal period than did the controls. A higher proportion of fat in the initial part of the breakfast was related to a larger meal size for the bulimics. It is suggested that these techniques may be useful in evaluating the outcome of treatment for eating disorder patients.

The effects of depression and treatment on the tridimensional personality questionnaire

Given the success of the Tridimensional Personality Questionnaire (TPQ) in delineating personality characteristics of eating disorder patients, the present investigation was designed to evaluate the stability of TPQ scores. This was done by examining the effects of depression on TPQ scores before and after treatment in eating disorder patients and normal controls

Comparison of body size estimation and eating disorder inventory scores in anorexia and bulimia patients with obese, and restrained and unrestrained controls

Psychological attributes and body size estimation were compared in four subgroups of anorexia and bulimia patients, an obese group, an unrestrained control group, and a restrained control group. The four patient subgroups were anorectic-restrictors, anorectic-bulimics, bulimics with a history of anorexia, and bulimics without a history of anorexia. The bulimics with a past history of anorexia displayed the greatest degree of psychopathology, as measured by the Eating Disorder Inventory (ED/). Of the four anorexia and bulimia subgroups, the anorectic-restrictors displayed the least pathological EDI profile while the anorectic-bulimics and bulimics with no history of anorexia displayed intermediate profiles. All anorexia and bulimia subgroups overestimated the size of their hips and their body depth relative to the two control groups and the obese group. There were no differences in body size estimation between the subgroups of anorexia and bulimia patients. All four groups of patients showed improvements on both the EDI and body size estimation task with treatment. The implications of these findings for diagnostic criteria and appropriate subgrouping of anorexia and bulimia patients is discussed.

Anorexia Nervosa and Bulimia Nervosa in Adolescence: Effects of Age and Menstrual Status on Psychological Variables

OBJECTIVE To compare, in adolescents and adults with anorexia nervosa and bulimia nervosa, eating disorder symptomatology and comorbid affective and anxiety states. METHOD Two hundred fifty consecutive, female inpatients on an eating disorders unit were studied. They were given the Beck Depression Inventory; the Depression, Obsessive-Compulsive, Anxiety, and Phobic Anxiety scales from the Symptom Checklist 90; and the Eating Disorder Inventory. Patients were divided into categories based on age, diagnosis, and menstrual status. RESULTS Onset of anorexia nervosa before age 14 and primary amenorrhea were associated with the greatest maturity fears during acute illness. For patients with restricting anorexia, adolescents aged 17 through 19 years had the highest drive for thinness compared to adolescents aged 13 through 16 years and adults. The lowest levels of depression and anxiety were seen in patients younger than age 14 with restricting anorexia. CONCLUSION Overall, few psychological differences between adults and adolescents with eating disorders were found, with the exceptions of the youngest restricting anorectic patients at the time of treatment and both restricting and bulimic-anorectic patients who had a very early onset of their illness. Younger patients with acute anorexia nervosa may not require pharmacotherapy for anxiety and depression and may benefit from a focus on maturity fears in psychotherapy.

Psychometric validation of the Tridimensional Personality Questionnaire : application to subgroups of eating disorders

Eating disorder patients show extremes of the personality characteristics measured by the Tridimensional Personality Questionnaire (TPQ). For this reason, the TPQ was tested in four subgroups of eating disorder patients. Patients completed the TPQ and their responses were compared with a normative sample of women. Results indicated that the TPQ is an internally consistent and valid instrument to use with eating disorder patients.

Psychosis in Alzheimer's Disease is Associated with Frontal Metabolic Impairment and Accelerated Decline in Working Memory: Findings from the Alzheimer's Disease Neuroimaging Initiative

OBJECTIVE An ascendant body of evidence suggests that Alzheimer disease with psychosis (AD+P) is a distinct variant of illness with its own genetic diathesis and a unique clinical course. Impaired frontal lobe function has been previously implicated in AD+P. The current exploratory study, presented in two parts, evaluates both the regional brain metabolic and psychometric correlates of psychosis in a longitudinal sample of subjects with AD, made available by the Alzheimers Disease Neuroimaging Initiative (ADNI). METHODS In Part 1 of the study, 21 ADNI participants with AD who developed psychotic symptoms during the study but were not psychotic at baseline were matched with 21 participants with AD who never became psychotic during the study period, and mean brain [F(18)]fluorodeoxyglucose positron emission tomography (FDG-PET) Cerebral metabolic rate for glucose (CMRgl) by regions of interest (ROIs) were compared Additionally, 39 participants with active psychosis at the time of image acquisition were matched with 39 participants who were never psychotic during the study period, and mean brain FDG-PET CMRgl by sROI were compared. In Part 2 of the study, 354 ADNI participants with AD who were followed for 24 months with serial psychometric testing were identified, and cognitive performance and decline were evaluated for correlation with psychotic symptoms. RESULTS Part 1: There were no regional brain metabolic differences between those with AD destined to become psychotic and those who did not become psychotic. There was a significant reduction in mean orbitofrontal brain metabolism in those with active psychosis. Part 2: Over the course of study follow-up, psychosis was associated with accelerated decline in functional performance as measured by the Functional Assessment Questionnaire, the Mini-Mental State Examination, and Forward Digit Span. CONCLUSION In a sample drawn from the ADNI dataset, our exploratory FDG-PET findings and longitudinal cognitive outcomes support the hypofrontality model of AD+P. Focal frontal vulnerability may mediate the accelerated decline seen in AD+P.

A comparative analysis of Minnesota Multiphasic Personality Inventory profiles of anorexia nervosa at hospital admission, discharge, and 10-year follow-up

The assessment of personality variables measured by the Minnesota Multiphasic Personality Inventory (MMPI), was compared in a sample of 52 female inpatients with anorexia nervosa at the time of hospitalization, discharge from hospital, and 10 years after treatment. Admission MMPI scores were significantly higher than scores both at discharge and 10 years later. There were no significant overall differences between discharge and follow-up evaluation. Discharge, but not admission, MMPI scores were positively correlated with 10-year follow-up study on seven of 10 clinical MMPI scales (all but hypochondriasis, masculinity/femininity, and hypomania). At follow-up evaluation, eating disorder poor outcome was associated with higher MMPI scores. There was no significant difference on admission MMPI scores between the four outcome groups; however, patients who recovered had a greater decrease in MMPI scores at the 10-year follow-up study compared with poor outcome patients. The long-term outcome of anorexia nervosa was largely unrelated to the severity of psychopathology during the acute phase of the illness. These results suggest that persistent personality features are best measured following treatment of acute symptomatology of anorexia nervosa.